Disclosure

Private Session Agreement

About Grace Since 2000, I have studied many forms of holistic, alternative healing methods for personal growth and healthy lifestyle. In 2005 I became totally disabled with Chronic Mono/EBV and Fibromyalgia symptoms. My three-year journey led me to many options, which helped me manage my symptoms, but did not release the cause. Ultimately Linda Esser introduced me to FasterEFT—(Faster Emotionally Focused Transformation), developed by Robert G. Smith. FasterEFT is a comprehensive set of personal transformation skills, which release stress, the leading cause of all problems and symptoms. In my first week of FasterEFT tapping I began to heal immediately and I believed if I continued to practice it daily, it would heal me completely. I also recognized that it would heal virtually anything I address with it and I began to try it on everything with success. After 2½ years of daily practice I was completely healed from the disability. I no longer have to manage it, because it is gone. I am healthier and better than before disability. These highly successful techniques have been used by thousands of people all over the world. Robert G. Smith certified me as a FasterEFT/Life Care Practitioner on June 15, 2009 and as FasterEFT Master Practitioner on October 29, 2010.

My mission is to teach personal transformation skills that will enable you to release stress, give you increasing control of your thoughts and emotions, and create a positive affect in the quality of your life.

Disclosure, Responsibility Statement & Client Agreement (The “client” is the signer below)

1. I (the client) understand that B. Grace Jones is not a licensed counselor, psychologist, therapist, medical doctor, nutritionist or any other medical professional, she has no formal training in these fields and she does not portray herself as such.

2. I (the client) accept complete responsibility for my emotional and/or physical well being before, during and after sessions or classes, and I will in­struct others I share these techniques with to take the same responsibility for them.

3. I (the client) agree that it is my responsibility to notify my therapist and/or physician prior to using these skills and agree to their supervision if suggested. I will continue to take all my medications as prescribed and remain under the care of my physician or therapist for any medical, emotional or mental condition for which I am currently being treated or believe I may need treatment.

4. I (the client) fully understand that these techniques are considered experimental and even though thousands have gotten positive results, there are no clinical trials or studies. I understand that there is no guarantee that I will have positive results.

5. I (the client) will not use these techniques to try to solve a problem where my common sense would tell me it is not appropriate.

6. I (the client) take full responsibility for what I do with these techniques, and will hold harmless B. Grace Jones, or anyone else associated with the techniques, from any claims made by myself, or anyone whom I seek to help. Subject to the other provisions of this agreement, I may use any of the techniques on behalf of others or myself.

7. I (the client) understand that the services provided by B. Grace Jones are limited to education pertaining to my overall wellbeing. I under­stand these services may include her physically tapping on my body at various acupressure meridian points. I grant my permission for limited physical contact. I agree to tell her immediately if it causes me any physical discomfort. I understand that these techniques may reveal some problems I had forgotten, but they don’t cause new problems. I understand I can accept or not accept any recommendations and I can terminate our relationship at any time.

8. I (the client) understand that my full identity will NOT be disclosed without my prior consent, if the issues I address during PRIVATE SES­SIONS are shared with others in a general way for the purpose of educating them about these techniques.

9. In the event I (the client) am in a group session or class, which is being recorded on video and/or audio media, I agree for B. Grace Jones to use my name, image, likeness and/or voice. I hereby release all claim on confidentiality, interest, royalties, reproductions, distributions and public access of such media.

10. In the event a private session is recorded on written document, video or audio media, I (the client) understand that all records are confidential and will be for private use by B. Grace Jones or made available to me for an additional fee. Any records of private sessions will not be viewed by anyone else without my prior written consent.

11. I (the client) acknowledge that I have read the above agreement, understand it completely and have received a copy of the same. I therefore retain B. Grace Jones as a FasterEFT Master Practitioner and voluntarily make and grant this Waiver and Assumption of Risk in favor of B. Grace Jones of Denali Dragonfly Options To Live Well as consideration for monies paid to the Provider.

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